7/25/2023 0 Comments Define meta in metacarpalThe thumb is often considered a separate entity from the fingers and is formed from only two phalangeal bones referred to as proximal and distal, it therefore only contains one interphalangeal joint. The joint capsule is reinforced on its volar aspect by the thickened ligament known as the volar plate that prevents hyperextension of the joint. These joints are hinge joints that allow each finger to have two separate points of flexion and extension along its length. There are two joints between the three phalanges in each finger, which are the proximal and distal interphalangeal joints (PIPJ, DIPJ). The phalanges reduce in size from proximal to distal. These bones are arranged lengthways in relation to each other to give the long thin characteristic shape of the finger. The fingers are formed by three phalanges - proximal, middle and distal phalanx. The structure of each phalanx is similar to that of the metacarpal bones, each has a base, shaft, neck and head that is formed from two condyles. There are fourteen phalangeal bones in the digits of the hand. The five digits of the hand begin at the MCPJ and are formed by the phalanges. These are condyloid joints that allow flexion and extension of the digits, as well as a very small degree of abduction and adduction when the digits are extended. They articulate with the proximal phalanx of each digit to form the metacarpal-phalangeal joints (MCPJ), which are more commonly known as the ‘knuckles’. The heads of the metacarpals are prominent structures and can easily be felt especially when the hand is made into a fist. The dorsal surface of each metacarpal head is broad and flat, whilst the palmar surface has a central depression for the passage of the flexor tendons. The shaft of each metacarpal widens at its distal end to form a neck and finally the metacarpal head. The body or shaft of each metacarpal is curved and this gives the palm of the hand its characteristic cup shape. Each metacarpal has a base that articulates with the distal row of carpal bones. The metacarpal bones are numbered one to five, with one corresponding to the thumb and five the little finger. The main body of the hand is formed by the five metacarpal bones, and is commonly referred to as the palm. Fractures to carpal bones are relatively uncommon and will not be discussed. They are arranged into two separate rows, with the proximal row forming part of the wrist joint and the distal row articulating with the base of the metacarpal bones in the palm of the hand. The carpal bones form the base of the hand and the wrist joint, there are eight in total which are small and irregularly shaped. These terms are important when describing fractures and how they are displaced, subluxed or angulated. The two lateral borders of the hand are commonly referred to according to their relation with the bones of the forearm, with the thumb forming the radial border and the little finger relating to the ulnar border. The hand has a volar surface that includes the palm, and a dorsal surface that is commonly referred to as the “back” of the hand. There are twenty-seven bones within the hand, arranged into three distinct groups - carpals, metacarpals and phalanges. Each hand is attached to the forearm at the wrist joint. The hand consists of a main body known as the palm and five digits - a thumb and four fingers. Despite this being the case, this paper intends to deal mainly with the bone injury and aims to discuss both the timing, as well as the methods available, of hand fracture management. These decisions are dependant on a wide range of factors including age, hand dominance, occupation and co-morbidities.Ī fracture is best described as a soft tissue injury with an associated bony injury. Appropriate evaluation at first presentation, as well as during their management, can significantly prevent both morbidity and disability to a patient. Hand fractures are the most common fractures presenting at both accident and emergency and within orthopaedic clinics. Allowing the ability to grasp, and differentiated from other animals by an opposing thumb, the main functions include both fine and gross motor skills as well as being a key tool for sensing and understanding the immediate surroundings of their owner. The hand is essential in humans for physical manipulation of their surrounding environment.
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